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WASHINGTON -- Government investigators found no proof that delays in care
caused veterans to die at a Phoenix VA hospital, but they found plenty of
problems that the Veterans Affairs Department is promising to fix.

Investigators uncovered large-scale improprieties in the way VA hospitals and
clinics across the nation have been scheduling veterans for appointments,
according to a report released Tuesday by the VA's Office of Inspector General.

Revelations that as many as 40 veterans died while awaiting care at the Phoenix VA hospital rocked the agency last spring, bringing to light scheduling problems and allegations of misconduct at other hospitals as well.

 Eleven staff stated they "fixed" or were instructed to "fix" appointments with wait times
greater than 14 days. They did this by rescheduling the appointment for the same date and
time but with a later desired date.

 Twenty-eight staff stated they either printed out or received printouts of patient information
for scheduling purposes. Staff said they kept the printouts in their desks for days or
sometimes weeks before the veterans were scheduled an appointment or placed on the EWL.

"Inappropriate scheduling practices are a nationwide systemic problem," said
the report by Richard Griffin, the VA's acting inspector general. "These
practices became systemic because (the Veterans Health Administration) did not
hold senior headquarters and facility leadership responsible and accountable."

The report could deflate an explosive allegation that helped launch the scandal
in the spring: that as many as 40 veterans died while awaiting care at the
Phoenix VA hospital. Investigators identified 40 patients who died while
awaiting appointments in Phoenix, the report said, but added: "While the case
reviews in this report document poor quality of care, we are unable to
conclusively assert that the absence of timely quality care caused the deaths of
these veterans."

Nevertheless, top VA officials said the report's findings were troubling.

Addressing the American Legion's national convention in Charlotte, N.C.,
President Barack Obama said lengthy wait times and attempts to hide scheduling
flaws were "outrageous and inexcusable."

"We are very clear-eyed about the problems that are still there," Obama said. "And those problems require us to regain the trust of our veterans and live up
to our vision of a VA that is more effective and more efficient and that truly puts veterans first. And I will not be satisfied until that happens."

"I'm glad that veterans didn't die because of delays in care or at least they weren't able to conclude that they did," Deputy VA Secretary Sloan Gibson said in an interview.

"I'm glad that veterans didn't die because of delays in care or at least they
weren't able to conclude that they did," Deputy VA Secretary Sloan Gibson said
in an interview. "But the fundamental issue is, veterans are waiting too long,
and that's the problem we've got to face."

In a memo responding to the report, VA Secretary Robert McDonald apologized to
veterans and pledged to implement the 24 recommendations in the inspector
general's report.

"We sincerely apologize to all veterans and we will continue to listen to
veterans, their families, veterans service organizations and our VA employees to
improve access to the care and benefits veterans earned an deserve," said
McDonald's memo, which was also signed by Carolyn Clancy, VA undersecretary for
health.

"What happened in Phoenix is inexcusable and must never happen again in any VA
facility," said the Vermont independent. "The people who lied or manipulated
data at Phoenix and elsewhere must be held accountable."

Glen Costie, the interim director for the Phoenix VA, also added his "deepest apologies" to veterans but also assured them that great strides have already been made, hoping to restore their trust.

"I am pleased to announce that of the 13 recommendations specific to the Phoenix VA health care system made by the Office of Inspector General, 10 have been addressed, and we will be submitting our progress for review by the OIG," he said in a press conference.

In April, Dr. Samuel Foote, who had worked for the Phoenix VA for more than 20
years before retiring in December, told Congress that up to 40 patients died
while awaiting care at the hospital. Foote accused Arizona VA leaders of
collecting bonuses for reducing patient wait times. But, he said, the purported
successes resulted from data manipulation rather than improved service for
veterans.

The allegations rocked the agency. Eric Shinseki resigned as VA secretary. In
July, Congress approved spending an additional $16 billion to help shore up the
system.

On Tuesday, Foote said parts of the report were a "false representation" of events, in a potential attempt to discredit him.

The report alleges that someone referred to as "the whistleblower" was unable to provide the OIG with 40 pages of veterans' names, including those who had died.

Foote said that is patently false.

"We showed them a report on the electronic wait list that indicated that 22 had been removed because they had died. We had two of those names," Foote told KTAR News' Bruce St. James and Pamela Hughes Tuesday. "We showed them that there were 18 patients who died [on another list] and gave them the names of 17...as time went by, we provided them with 5 more names."

"We showed them a report on the electronic wait list that indicated that 22 had been removed because they had died. We had two of those names," Foote told KTAR News' Bruce St. James and Pamela Hughes Tuesday. "We showed them that there were 18 patients who died [on another list] and gave them the names of 17...as time went by, we provided them with 5 more names."

Foote added that he was concerned by the phrase "conclusive assert," as it pertains to the report that no veterans died because of delays in care.

"What charts did they look at? How many did they look at? And what kind of
standard is 'conclusively assert'? Foote said. "Without question, their
statement was worded such that the reader will assume that no harm came to the
patient due to the delay in care. That is unlikely to be true."

The inspector general runs an independent office within the VA. The
investigation was done by a team of physicians, special agents, auditors and
health inspectors, who reviewed VA medical records and outside medical records
for patients who died while waiting for care, the report said. They also
reviewed more 1 million emails and 190,000 computer files.

"This report cannot capture the personal disappointment, frustration and loss
of faith of individual veterans and their family members with a health care
system that often could not respond to their mental and physical health needs in
a timely manner," the report said. "Immediate and substantive changes are
needed."

The VA has said it was firing three executives of the Phoenix VA hospital. The
agency has also said it planned to fire two supervisors and discipline four
other employees in Colorado and Wyoming accused of falsifying health care data.

Gibson said he expected the list of disciplined employees to grow.

"The fundamental point here is, we are taking bold and decisive action to fix
these problems because it's unacceptable," Gibson said. "We owe veterans, we
owe the American people, an apology. We've delivered that apology. We'll keep
delivering that apology for our failure to meet their expectations for timely
and effective health care."

To help reduce backlogs, the VA is sending more veterans to private doctors for
care.

Congress approved $10 billion in emergency spending over three years to pay
private doctors and other health professionals to care for veterans who can't
get timely appointments at VA medical facilities, or who live more than 40 miles
from one.

The new law includes $5 billion for hiring more VA doctors, nurses and other
medical staff and $1.3 billion to open 27 new VA clinics across the country.

The legislation also makes it easier to fire hospital administrators and senior
VA executives for negligence or poor performance.